HomeMy WebLinkAboutMortgage_Hosmer a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ounty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Finance
File Mark
INSTRUCTIONS: ^,1(., c46 .2p14 Form coed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county w e property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. W County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must Me du ' the Ave months County Recorder
before March 31 of each year the deduction is sought - Up, OITOR
See reverse side for additional instructions and qualifications. vraCON COUNTY
Applicant(ocontract buyer-.zee restrictions orrreverry side���
)
at, 6Y// al description num
iazirg District Key a number ip--a/ 9 31 -30 if 000 3g-ti 0 s `� G ,g6/
Assessed value of real property as of O,C Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,accent year March 1,cement year date of application legal or equitable owner?
7350 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. I the property in question:Annually Assessed
eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name at }—xer
Address of mortgagee or contract setter(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
s
Address of assignee(number and street city,state,and ZIP code` _-___
Does applicant own property in any other If yes,s --�- , I Has this deduction been requested an property .
county in Indiana? ID Yes ❑ No `�/l ,j J year? ❑ Yes ❑ No
Deduction approved in the amount of 14-36)6 r .
20 20 20 20 20 .
Signature of County Auditor s County i Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Slgnatu/o.- Ulna ) / Date(month,day,year)
/
e/7 G/P `f
F _.�o ... .d (numr' ant t.an sta and code
F/Al .S 3 o
.- • authorized by duty executed Pourer of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .